HomeMy WebLinkAbout1979-04-21 Water Well RecordSTATE: OF MINNFSOTA
Vosionry
Toliml,olp Manor Township Numhet Range Numhoer Sectlnn
�a�aoo 11744 5 23-w W
Distance and 1lkeetit►n from Road Iniersectlr►ns or Street AdJ►ess and Cily of Well Location
Show easel IsKalson of well in sectWn grad with "X."
M
2
5
M"-...- 1 wi IS ----�
FORMATION LOG
HI
E
T
1
AddtlNM Name
block Number
Lot Numhet
COLOR
Yellow
s l t
UEPARTMENTOf HEALTH
MINNESOTA UNIQUE WELL NO.
WATER WELL RECORD
Jo. l/'ia►er SdnrOfe
Afinrwtora Sanwret 134A.111..Ox 1 157870
1 rastir►n 3. PROPERTY OWNLRS NAML
o X iii` ev Jaek 44th!�91
Address 1390 ;;y
�
Oreso
Sketch map of well location.
10,.P)NII FROM
W,
�m
4. Wt LL DEPTH (completed)
Dole of Cam pktion
11 V
I ft
I h
S.
10L'shk Itxd
NEON
20Hrdlowrr►d
SOAor 60 Mired
2 R4P1°ry
6Olelfed oO Wrwer Auger
6. USE
Drive Shot?
la Domestic
401"uhltc Supply
21:1 lrtt#atlttn
SO Munlclpsl
10 lest Well
MENE
7. CASING
HEIGHT Above/below
Weight
_ Ito /ft.
In. to fl.
Weiahl
IM /ft
S. SCRV-EN
EM
Or
"Pen t
NERIEN10i
5
M"-...- 1 wi IS ----�
FORMATION LOG
HI
E
T
1
AddtlNM Name
block Number
Lot Numhet
COLOR
Yellow
s l t
UEPARTMENTOf HEALTH
MINNESOTA UNIQUE WELL NO.
WATER WELL RECORD
Jo. l/'ia►er SdnrOfe
Afinrwtora Sanwret 134A.111..Ox 1 157870
1 rastir►n 3. PROPERTY OWNLRS NAML
o X iii` ev Jaek 44th!�91
Address 1390 ;;y
�
Oreso
Sketch map of well location.
10,.P)NII FROM
W,
�m
4. Wt LL DEPTH (completed)
Dole of Cam pktion
11 V
I ft
I h
S.
10L'shk Itxd
40 Reverse ?l_.JI►tt,en
20Hrdlowrr►d
SOAor 60 Mired
2 R4P1°ry
6Olelfed oO Wrwer Auger
6. USE
Drive Shot?
la Domestic
401"uhltc Supply
21:1 lrtt#atlttn
SO Munlclpsl
10 lest Well
60 An ('t►ndrtioning
7. CASING
HEIGHT Above/below
100 out
110
fblack
Threaded
20(.4Iv.
SOWelded
Surface
ft.
60
Drive Shot?
YesAv— No
M. to •03 fl.
Weight
1 Ihs./ft.
in. to h.
Weight
_ Ito /ft.
In. to fl.
Weiahl
IM /ft
S. SCRV-EN
Or
"Pen t
70 Industry
BF-ii'ommerctal
OO
HOLT_ DIAM
. toil
nt. to fl.
in. to fl.
Make from ft. Ici ft.
07 Type as Dia.
Vol/C;iuse Length
FITTINGS.
Set hetween ..� ft. ano�ft
ft. and fl. ,Y" P•olar
ft. and ft
', SIAIIC WAt1.R LEVEL
I1 1 ftt.F.tw 00hote
land surface
10. PUMPING LLYt:i. (heluw land surface►
f ►alr Measured hal J
ft alter firs puml•rng it p.m.
It after hts. pumping R p.m.
If. NLLLHLADCOMPLLTION
�1'fUr„ adaptrr 20lisument offset t _At At trail 12 &N.,c
grade
12. Well grouted?
Yes AsNo Cu Yd►
1 _� Neat ( or 2LJ Beninnrte 3ij
Depth from fl. to If.
from ft, to ft.
13 Nearesl al)urCe+ of pusaihle ct►mamtnatlan
feet dwec wort
Nell drs�n/rcted u1mbn ao,mplrlkM' Ya] N"I A
14 PliMp
type
Dalr otsialled
Not tn,talled
Manufactutef's Name dos 46 . mwL
visas,1 - Model Numbers �' NP Yolts
1�
Length of drop pipe Tom` ft c apathy
CJ
1 Material of drop pipe
..r ;46 1W 0
T 1 pe )i�1 "uhmrr,tNr 1 1 ... urhtne S14J Net tpr#K still#
r'
I�-J let a < nt�.t.,t11 W-1
,
16. WATER WLI_L LON I RAL IOR'S t I R I If ICA IION
"is well was drdlyd under my lutisdtcturn ani this repeal to Ihir Io
r
the terse of my knn,►tedge and t+etief.
_ rnr1llKiffila I. ent'e T
I to, a fee -find thrrF. of needed
IS. RIMARK5.1_Lt.VAt10N.SOUIKt O/ DAIA.ctt
r•
Signed
Awhe►rterd Hrpresentatrw
Join Dears*
Name of Ihdlrr
1►ate _ ��
Wit
5 '4 10M
7 ft) 401101